Thread by @pashtoonkasi

Yesterday at #TargetedChat we talked about a challenging case of a young individual with recurrent UNRESECTABLE colon cancer after adjuvant.

Here’s a 🧵 on the questions/answers. No one right away. What would you do differently?👇🏾Read/reply along #ColorectalCancerAwarenessMonth

It was interesting to see the distribution on the chemo backbone options.

TRIPLETS 🆚 DOUBLETS #TargetedChat #CRCSM

👇🏾With the doublets and triplets discussion, a little bit of art 🖼 to the science 🧪

Have to see and individualize in each patient which tools 🛠 from the toolbox 🧰.

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But before you start any standard of care, what’s better than standard of care? ✅ #ClinicalTrials

A🔌 for @ALLIANCE_org SOLARIS 🌞 @KimmieNgMD study.

🙋🏻‍♂️Teaching point: won’t have qualified for trial since recurrence within 12 months would mean ➡️ 2nd line for this patient.

Prior cumulative exposure to oxaliplatin would come into play. Too often overused.

6 months of chemo doesn’t mean 6 months of oxaliplatin.

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#ColorectalCancerAwarenessMonth

The biologic choice here 1st line with RIGHT-sided colon would be VEGF⛔️.

Look 👀 at the striking lack of benefit of EGFR⛔️.

This is 1st line. Beyond 1st line, it’s a whole different debate but available as an option in 🇺🇸. I know our European colleagues have it 1st line too.

I typically switch to some form of ✅maintenance therapy sooner than later.

What’s maintenance?

Choose your own definition👇🏾

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Also from a dosing standpoint, I’d say we should come up with a new name for the triplet chemo 🇺🇸 dosing.

The 2400 mg/m2 modified version of FOLFOXIRI & now the standard modified FOLFIRINOX are the same technically.

Maybe 🤔 .. takers?

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I’d point out, the data on triplets is evolving and they tend to be underutilized.

As my basic scientist colleague would say: future is “multi-drug multi-targeted therapy”, with my addition “rational combinations”. Human beings don’t behave as Petri dishes 🧫.

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